After treatment, there may be a small number of cancer cells that remain in the body. This is referred to as minimal residual disease (MRD). The remaining number of cells may be so small that they do not cause any physical signs or symptoms.
They usually go undetected through traditional methods, such as viewing cells under a microscope or by checking for abnormal serum proteins in the blood. If a patient receives a MRD positive test result, it means that residual (remaining) cancer cells have been detected. A negative result means that no residual disease is detected.
Any remaining cancer cells can become active and begin to multiply, causing the patient to relapse. MRD assessment helps indicate if the treatment was not completely effective. Minimal residual disease might be present after treatment because not all the cancer cells responded to therapy.
A positive test result for MRD, known as “MRD positivity”, indicates that residual cancer cells are present in the body after treatment. When a patient tests negative for minimal residual disease, known as “MRD negativity”, there are no remaining cancer cells.
Being “MRD negative” is an encouraging outcome for a patient with blood cancer. MRD negativity means that even with advanced, sensitive tests, no cancer cells were detected. According to studies, MRD negativity is associated with longer remissions and potentially longer rates of survival for certain blood cancers.
Testing for MRD can help our treatment team distinguish between patients who need additional or different treatment from those who do not. This knowledge can also guide treatment decisions and improve patient outcomes.
Minimal residual disease testing helps:
Testing for MRD in patients is dependent on varying factors specific to the patient’s disease.
Patients may be tested:
MRD testing uses highly sensitive methods such as flow cytometry, polymerase chain reaction (PCR), and next-generation sequencing (NGS). Each of these tests uses bone marrow cell samples taken through aspiration, or peripheral blood cells taken through a vein.
The type of MRD testing used depends on the type of blood cancer.
Acute Lymphoblastic Leukaemia (ALL) and Acute Myeloid Leukaemia (AML)
For patients with ALL and AML, MRD is detected through flow cytometry, PCR, and NGS.
Chronic Lymphocytic Leukaemia (CLL)
For patients with CLL, MRD is detected by flow cytometry and PCR.
Chronic Myeloid Leukaemia (CML)
For patients with CML, MRD is detected through PCR.
Lymphoma
For patients with lymphoma, MRD is detected through flow cytometry and PCR.
Myeloma
For patients with myeloma, MRD testing uses flow cytometry, NGS, and imaging tests.
Depending on the condition, restarting treatment again such as chemotherapy, radiotherapy or immunotherapy may be required. After detecting minimal residual disease, some patients may be candidates for stem cell transplantation or combination therapy.
While 80-90% of children and young adults will respond to initial ALL treatment, it is estimated that approximately 10-15% will experience disease relapse. For adults, the risk of disease relapse is even higher at 40-50%.
While high-grade Lymphomas tend to progress more rapidly, a good proportion of high-grade Lymphomas can be effectively treated with a low risk of relapse.
Low-grade Lymphomas often respond well to treatments available. However, they are not usually cured and may recur eventually over time.
Acute myeloid leukaemia is an aggressive and fast-growing cancer. A patient’s outcome depends on the type of AML they are diagnosed with, their individual health, and recommended treatment plan.
While many cases of AML can be cured with treatment such as chemotherapy or a bone marrow transplant, the outcomes still depend on the patient’s age and fitness, as well as the AML risk groups.
For patients with standard risk AML, approximately 50% of patients may be successfully treated with existing treatments. For patients with favourable risk AML, approximately 60-70% of patients may have a durable remission. However, for patients with poor risk AML, the chances of a durable remission are less than 25%.
While there is, unfortunately, no cure for multiple myeloma currently, treatment such as chemotherapy and immunotherapy, amongst others, can be used to successfully manage the condition for years.
With the introduction of novel drug therapies, as well as the use of 3-4 drug combinations for upfront treatment of myeloma, the majority of newly diagnosed myeloma patients are able to achieve a partial or complete response to initial therapy.
Many of these patients will eventually relapse over time. Treatment strategies such as the use of autologous stem cell transplantation, as well as the use of longer term maintenance therapy have been adopted successfully to delay the time to relapse (ie. prolong the disease free interval)
These approaches do not factor in variables such as age and overall health. Speak to our doctor for a better understanding of the success rates of your treatment plan.
The information on the Centre For Clinical Haematology website is intended for educational use. It should not be considered or used as a substitute for medical advice, diagnosis or treatment from a qualified health professional.
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The CFCH team is committed to providing patient-centred care and comprehensive multidisciplinary support through every stage of your journey with us.
During your initial consultation, you'll meet our doctors who will listen to your concerns and begin your evaluation and recommend the necessary investigations required.
After diagnosis, we will plan your care, tailoring treatment options to your unique needs for the optimal outcome.
Throughout your treatment journey, we will provide a supportive environment to closely monitor your progress, ensuring your comfort and adjusting care as needed.
After treatment, we will continue to support you with a holistic approach to your recovery, to ensure that both your physical and mental wellbeing are looked after.
